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Preventing Opiate Overdoses: Nurses Can Play a Key Role.

In 2016, more than two Arizonans died every day due to opioid-related causes, with a tripling in the number of deaths due to heroin since 2012. On June 5, 2017, Governor Doug Ducey issued his first public health emergency declaration, which called for a statewide effort to reduce opioid deaths in Arizona. The Department of Health (ADHS) established an Enhanced Surveillance Advisory following the declaration. The Surveillance reported 1213 suspected opioid deaths and 7730 suspected overdoses since June 15, 2017. (www. azhealth.gov/opioid) On April 26, 2018 the Opiate Act went into effect and will impact prescribers, patients, and nurses in all practice areas.

It is often difficult to move evidence to the practice setting. However, when official policy is involved it becomes a requirement to know the new laws, understand how to be the best patient advocate, and respond to patients' concerns in a way that is supportive. Below is practical and valuable information that every nurse needs to know.

Patient Safety

Preventing harm to patients from medications, or adverse drug events, is a patient safety priority, not only in hospitals, but also across the continuum of care. An overdose is an example of an adverse drug event. People who have a nonfatal drug overdose are at a very high risk for another overdose.

So improving the discharge process from hospitals and integrating overdose education are opportunities for intervention that may result in improved patient health and preventing death.

Who is at risk for overdose?

* Anyone taking a high daily dose of opioids, coprescription of benzodiazepines or who have a history of overdose are at risk for overdose from opioid abuse

* Patients receiving rotating opioid medication regimens (and thus are at risk for incomplete cross-tolerance)

* Patients discharged from emergency medical care following opioid overdose

* Patients with a legitimate medical need for analgesia (chronic pain), coupled with a suspected or confirmed history of substance abuse, dependence or non-medical use of prescription or illicit opioids

* Someone who is completing mandatory/ voluntary opioid detoxification or abstinent for a period of time

* Someone who was recently released from incarceration and a past user or abuser of opioids

Advocacy and Education

In April 2018, Dr. Jerome Adams, the US Surgeon General, issued a rare public health advisory calling on more Americans to carry naloxone, a lifesaving medication that can reverse the effects of an opioid overdose. Naloxone is an opioid antagonist that is used to temporarily reverse the respiratory depressant effects of an opioid overdose. Dr. Cara Christ, Director Arizona Department of

Health Services (ADHS) issued a standing order for naloxone in 2017. This means that if a patient is unable to obtain a prescription for naloxone, they can still access the drug at a pharmacy. Nurses can inform patients at risk and their families to purchase naloxone at home for ease of access. It's easy to use.

Overdose education includes teaching your patient /family how to recognize the signs and symptoms of an overdose. It can save a life. The person may become unresponsive and develop blue lips or blue fingertips. The breathing becomes slow (less than 1 breath every 5 seconds) or no breathing. They may make choking sounds or a gurgling, snoring noise. If family or friends see these symptoms, tell them to call 911, administer naloxone, and place the person in a position to facilitate breathing and avoid aspiration. (1)

Substance Use Disorder

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), "Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home." Opioid Use Disorder is one of the most common substance use disorders. Effective treatment for Opioid Use Disorder included medication prescribed in conjunction with behavioral therapies. Medication-Assisted Treatment (MAT) has emerged as an effective treatment. (See MAT May Be the Answer below).

Resources

ADHS has created resources to assist in providing care to patients who may have an underlying unrecognized substance use disorder. There are new prescribing guidelines that were released in March 2018 based on the latest evidence that include guidance for acute and chronic pain patients. Hospital discharge instructions have been developed to give guidance in identifying individuals at risk for overdose and recommending those patients receive at minimum a prescription for naloxone. Go to www.azdhs.gov, select A-Z index and click on "O." You will find information about the opioid epidemic and tools to help care for at risk patients.

Nurses are practicing on the front lines of the opioid epidemic; our patients and families are relying on us to do what we do best: care, advocate, listen and keep them safe.

Tomi St. Mars MSN, RN, CEN, FAEN is Chief: Office of Injury Prevention, Arizona Department of Health Services.

(1) SAMHSA Opioid Overdose Prevention Toolkit. HHS Publication No.16-4742. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2016.
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Author:Mars, Tomi St.
Publication:Arizona Nurse
Date:Aug 1, 2018
Words:821
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